Side-to-side and top-to-bottom images . Here's how to interpret your BMI: Below 18.5: underweight. Your member ID card is your key to using your medical plan benefits. . The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Frequency: May vary based on your health so ask your doctor, Certain breast pumps for pregnant and post-partum women, One manual or electric breast pump purchase per pregnancy is covered, Benefit available during third trimester (starting 11.1.16) or after member has delivered the baby, Breast pumps come with certain supplies, such as tubing, shields and bottles, Breast pumps must be purchased from participating Durable Medical Equipment (DME) vendors. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. Standard 2D mammograms take two pictures of the breast. You are viewing estimated values for an individual. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Negotiated rates with providers can change, therefore, changing the estimate. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. Servicing providers (hospitals, freestanding imaging centers, etc.) Please update your browser if the service fails to run our website. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Fraud and Abuse If you have a positive fecal blood test (gFOBT or FIT or Cologuard) or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. So why do so many women put off their mammograms? Provider Manual . Help Center. For this reason, 2D mammograms can sometimes produce inaccurate findings. If you get benefits from your employer, you may also have these benefits. Breast Cancer Mammography Screening Age 35-39 . Others have a false sense of . If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Breast cancer is the most common type of cancer in women. Recommended repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 2428 weeks gestation unless the biological father is known to be Rh (D)-negative, Anesthesia services will pay at 100% only for sterilization, Certain services for contraceptive device insertion and removal, such as ultrasounds to confirm IUD placement, will pay at 100%, Pregnancy tests prior to the initiation of contraceptive will pay at 100%. Site Map If something is found in a preventive screening mammogram, the screening is still at no cost to the member. You usually need to get tested every 3 to 5 years. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. You should call the number on the back of your member ID card for more information before you schedule one. 25 - 29.9: overweight. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. 104 0 obj <> endobj Disponible nicamente en ingls. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. endstream endobj startxref It happens in both men and women, but breast cancer in men is not common. No. It is important to note that these services are free only when delivered by a doctor or other . No. How long is an authorization of a diagnostic imaging procedure valid? Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. Coverage is subject to the specific terms of the member's benefit plan. In contrast, 3D mammograms use CT (computed tomography) scans. Screening mammograms every 12 months if you are a woman age 40 or older. Copy. Limited to a 90 day supply each for two cessation efforts. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Others have a false sense of . Has Blue Cross NC considered disallowing self-referrals? Coverage that is supplemental to Medicare but with no member cost There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Combined together, the X-rays create a three-dimensional picture of each breast. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Immunizations for you and your family. Telligent is an operating division of Verint Americas, Inc., an independent company that provides and hosts an online community platform for blogging and access to social media for Blue Cross and Blue Shield of Illinois. Necesita su ID de usuario? About 10% of patients who receive routine mammograms get called back for another look. Blue Cross Blue Shield Global Core gives Blue Cross and Blue Shield of Vermont members access to their health care benefits wherever they go - across the country and around the world. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. Usage Agreement Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Understand the difference between preventive and diagnostic. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . If you have an HMO or POS plan, there are some additional services you'll need approval for. There are also additional guidelines if you're pregnant. The USPSTF recommends biennial screening mammography for . Select Your Gender. Enroll Now. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. There is an appeals process in place for unfavorable determinations. No family history, no risk. Mammograms are for older women. No lump, no cancer. Do practicing North Carolina physicians have input into the program? "To put it in perspective, the dose of radiation is lower than that of a chest x . According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. File is in portable document format (PDF). Tobacco and alcohol use evaluations. Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for Blue Cross NC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue . Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. All rights reserved. endstream endobj 105 0 obj <. Check out the changes and updates to our plan in 2023. Breast tomosynthesis is an . Accessibility What process is in place for unfavorable determinations? TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. FDA-approved tobacco cessation prescription. Which health plans does the program apply to? When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. http://www.breastcancer.org/symptoms/understand_bc/statistics BCBSIL Provider Manual June 2020 2 . Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Linked Apps. Under the Affordable Care Act (ACA), CareFirst and other health insurance carriers must cover a set of preventive serviceslike shots and screening testsand no cost to you. . The remaining 40% are out-of-pocket costs. Description: Screening for cervical cancer. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Mammograms use very small doses of radiation and the risk of harm is very low. This can get confusing, so call your health plan before you go. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . This happens by feeling breast tissue for any lumps or abnormal areas. Women ages 35-39 can receive one baseline mammogram(four views). It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). (EOB) from Blue Shield of California to notify you that your claim has been processed. The site may also contain non-Medicare related information. Typical costs: For an uninsured patient, typical full-price cost of a mammogram ranges from $80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. Bacteriuria screening for pregnant women. Yes, they will cover annual mammograms if they are suitable to age. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. . Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for Blue Cross NC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans): Prior approval is not required when these procedures are performed in an emergency room, hospital (related to an inpatient or observation stay), urgent care center or ambulatory surgical center. Health plans are offered by Blue Shield of California. hrHPV test only every 5 years. One option is Adobe Reader which has a built-in screen reader. We'll be completing scheduled maintenance on Sunday (3/5) from 12 a.m. until 6 a.m. Blue Connect may be unavailable during this time. They'll also look for early signs of breast and cervical cancer. You must also receive prior approval from us. . Mammograms are one of the best ways to find it early. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. Fargo (Headquarters) We recommend receiving estimates close to . %PDF-1.5 % The cost estimate changed prior to your care. BlueCross BlueShield of South Carolina. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Evaluation of suspected breast cancer when other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer, and biopsy could not be performed (e.g. For evaluation of identified lesion, mass or abnormality in breast in. "When a provider recommends getting screened, it indicates the risks outweigh the benefit and it is deemed to be safe," Dallow said, adding that under the . Women ages 40 and older can receive a mammogram (four views) each calendar year. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Approve annually starting at age 30. should confirm that a prior approval number has been issued. Imaging costs have come to the forefront for employers and health plans because they have been growing at a faster rate than other segments of medical expenditures. We use cookies on this website to give you the best experience and measure website usage. Breast cancer is the second leading cause of cancer deaths among women in the U.S. 3D mammograms may be covered by your health plan. Copyright 2023 Health Care Service Corporation. Coverage Information. Learn more about our other insurance plans and Medicare plans, or contact a sales . Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Most breast cancers are found in women 50 years old and older. The following are the recommended vaccines for women that are covered with no out of pocket cost. During this visit, your doctor examines your overall health. https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 January 25, 2016. Mammograms are a key component of a womens preventative care. Learn more about our non-discrimination policy and no-cost services available to you. Blue Cross NC data confirm there is significant opportunity to contain health care costs and reduce member exposure to radiation by eliminating scans that are clinically inappropriate or noncontributory to the care. One its drawbacks is breast tissue can overlap during compression. Site Map The diagnostic imaging management program guidelines are based on the most up-to-date recommendations of physician organizations such as the American College of Radiology and the American College of Cardiology. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. When were Blue Cross NC's diagnostic imaging prior approval policies effective? If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. All women need to be informed by their healthcare provider about the best screening options for them. Learn more aboutmammogram screeningsin this video. We have an obligation to our members to provide quality care at an affordable price. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. 30 and above: obese. We will work with the physician community through our Diagnostic Imaging Management Advisory Group to assure that there is no negative impact on the quality of patient care as a result of this initiative. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . The age and frequency listed below are general recommendations. This information is a reference tool and does not guarantee payment of any claims. We believe that it is critical to carefully examine the appropriate use of outpatient, nonemergency diagnostic imaging procedures to make sure that the benefit of the procedure outweighs the risk. Some Blue Cross NCmembers who are employees of religious organizations and their dependents: Talk to your employer or check your benefit booklet to confirm your coverage for these benefits and any limitations.